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Panic Disorder

Perhaps panic disorder is the most known psychiatric disorder but it often misused and people love to call every anxiety symptoms panic attack. The symptoms, diagnosis, and treatment options will be mentioned below.




A panic attack is a condition that reaches its peak within minutes, and at that moment four (or more) of the following symptoms appear, suddenly by intense fear or intense internal distress.


1. Palpitations, heart beating or increased heart rate

2. Sweating

3. Tremors or shaking

4. The feeling of being short of breath or choking

5. The feeling that the breath is clogged

6. Chest pain or chest tightness

7. Nausea or abdominal pain

8. Dizziness, inability to stand, feeling lightheaded or faint

9. Chills, chills, chills or hot flashes

10. Numbness (numbness or tingling sensations)

11. A sense of unreality or self-alienation

12. Fear of losing control or going crazy

13. Fear of death


If what you read above meets your attack, you have had a panic attack. Having a panic attack alone does not meet the diagnosis of panic disorder. If you want to learn, what are the risks of panic disorder now , and what is called panic disorder keep going to read?


Predisposing Factors


Unfortunately, because "Human is a biopsychosocial entity" in psychiatric diseases, it is more complicated than other fields of medicine and harder to prove. Some of the risk factors for panic disorder as a result of researches are as follows; Early life events such as loss of parents in childhood, exposure to sexual abuse in childhood. Stressful life events were also accused of the formation of panic disorder. Some of these situations are: threatened to leave or leave a loved one, change jobs, pregnancy, migration, marriage, graduation from school, death of a close person, and physical illness. As with all psychiatric disorders, biological factors play a role in panic disorder. To date, various researches have been done, anomalies have been detected in the release and regulation of some hormones (such as excessive noradrenaline response, increased CRH levels), but none of them have been able to elucidate the etiology alone.




Just because someone has a panic attack does, not mean that they have a diagnosis of panic disorder. In addition to panic attacks, the person should have at least one month of panic attacks or be constantly worried or worried about their possible consequences (eg fear of losing control, having a heart attack). We also call this situation the expectation anxiety. Also, concerning to attacks, a person may behave in a manner of avoiding certain activities or behavior (for example, playing sports or going to places he does not know). As with all psychiatric disorders, this disorder significantly impairs both social and occupational functionality.


Differential Diagnosis


In a patient with the above-mentioned symptoms, ECG and TFT (thyroid function test) are first requested if it has not been done before to diagnose other medical conditions that may be the cause of the current panic attack before diagnosing a panic disorder. If these values ​​are normal, the possibility of panic disorder in diagnosis becomes stronger. Other diseases and physical conditions that should be considered in differential diagnosis;


  1. Hypoglycemia,

  2. Hyperthyroidism,

  3. Hypoparathyroidism,

  4. Cushing's disease,

  5. Pheochromocytoma,

  6. Poisoning or poisoning of psychoactive substances (barbiturate, amphetamine, cocaine, and caffeine)


What are the medical comorbidities?


Panic attacks frequently accompany heart diseases (such as MVP, angina pectoris), chest diseases (such as pulmonary embolism, asthma), menopause, anemia, endocrine (hyperthyroidism, hypoglycemia, Cushing's disease) and neurological diseases (migraine, transient ischemic attack).




There are a few typical features in the history of patients who are diagnosed with panic disorder in outpatient conditions. Patients with panic disorder applied to the emergency room at least once (usually more) before coming to the psychiatrist. Generally, there have been applications to cardiac doctors. Generally, patients apply to the psychiatry unit after a certain period time. Panic disorder is possible to treat and is a satisfying disease as a result of the collaboration between the patient and the doctor. There are two proven treatment types.


1. Pharmacological Treatments


Generally, the first option is SSRIs (sertraline, paroxetine, escitalopram, fluoxetine, fluvoxamine, citalopram). The response rate to treatment is high from the first month of treatment. How long the drug treatment will last and when it should be discontinued should be made by making a joint decision under the control of the doctor. One of the most common mistakes in daily practice is that the patient feels well and stops both control and medication on his own. Like all psychiatric disorders, panic disorder is a recurrent disorder.


2. Cognitive Behavioral Therapy (CBT)


There are two purposes in this treatment method:

  • It is aimed to correct the wrong information and beliefs of the patient about the symptoms of panic attacks which are completely harmless and to teach the patient to deal with these symptoms without fear.

  • The Panic Attack is intended to overcome its fears by gradually comparing it with the places and situations it avoids because it is afraid of its future.

In this treatment, the doctor gives his patient activities such as going out, going to the market, riding on vehicles, as exercises, starting from the simplest, within a plan, due to fear and panic. As the patient becomes able to do the simple, the exercises continue, until all the feared situations are over.




Panic disorder is possible to treat and is a satisfying disease as a result of treatment both in the patient and the doctor. As with all psychiatric disorders, the important factor in the treatment and course of panic disorder is that the patient-physician compliance is well achieved, the treatment (whether pharmacotherapy, psychotherapy, or combined treatment) is determined by the doctor and the patient's joint decision and discontinued when appropriate.


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